Future Reciprocal Healthcare Arrangements
Steve Barclay Excerpts(5 years, 6 months ago)
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The Minister for Health (Stephen Barclay)
Today, the Government are introducing the Healthcare (International Arrangements) Bill. This will provide the Government with the powers that are needed to fund and effectively implement arrangements for UK nationals to obtain healthcare abroad after the UK exits the European Union (EU).
Current EU reciprocal healthcare arrangements enable UK nationals to access healthcare when they live, study, work, or travel abroad and visa-versa for EU citizens when in the UK. They give people more life options, and support tourism, businesses, and healthcare co-operation. The UK also has a number of reciprocal healthcare agreements with non-EU and European Economic Area countries, such as Australia and New Zealand.
These arrangements ensure that UK nationals living and working in the EU, EEA and Switzerland can access healthcare in exchange for paying taxes and social security contributions. The UK also funds healthcare abroad for a number of current or former UK residents. This includes healthcare for UK state pensioners who spend their retirement in the EU and needs arising when UK residents visit the EU for holiday or study through the European healthcare insurance card (EHIC) Scheme.
The Bill is part of the Government’s preparations for EU exit and will ensure that whatever the outcome of EU exit, the Government can take the necessary steps to continue reciprocal healthcare arrangements or otherwise support UK residents to obtain healthcare when they move to or visit the EU.
Presently, the Secretary of State for Health and Social Care has limited domestic powers to fund and arrange healthcare outside the UK. When the UK leaves the EU the current EU regulations will no longer be part of UK law and new legislation will be needed.
This Bill confers powers on the Secretary of State to make and arrange for payments to be made in respect of the cost of healthcare provided outside the UK. This would allow for the funding of reciprocal healthcare arrangements for UK nationals living in the EU, EEA and Switzerland.
The Bill also confers powers on the Secretary of State to make regulations for and in connection with the provision of healthcare abroad and to give effect to healthcare agreements with other countries or territories (both EU and non-EU) or supranational bodies such as the EU.
Finally, the Bill provides for the lawful processing of data where necessary for purposes of implementing, operating or facilitating the operation of reciprocal healthcare arrangements or payments.
Current healthcare agreements benefit people in all parts of the UK, assisting people to obtain healthcare when they are abroad. The UK Government are therefore engaging with the devolved Administrations to deliver an approach that works for the whole UK in a way that fully respects the devolution settlements.
The Bill underscores the Government’s commitment to reaching a reciprocal healthcare agreement with the EU, or where necessary making agreements with member states, and to exploring potential agreements with third countries in the future.
The Government welcome the forthcoming scrutiny of the Bill, to ensure that it achieves its aims for the continuation of healthcare support for UK nationals in the EU, EEA and Switzerland after the UK exits the EU, but also enabling the UK to look to the future.
[HCWS1040]
Oral Answers to Questions
Steve Barclay Excerpts(5 years, 6 months ago)
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Alan Mak (Havant) (Con)
The Minister for Health (Stephen Barclay)
Having committed an additional £20 billion in real terms, the Government are asking the NHS to deliver a long-term plan that includes continued improvements in productivity and efficiency, and we are reinvesting the savings in improved patient care.
Damien Moore
I congratulate my hon. Friend on his drive to recycle more hospital equipment such as zimmer frames, crutches and wheelchairs, but what steps is his Department taking to encourage more hospitals such as Southport Hospital in my constituency to run recycling programmes to reduce waste in our NHS?
Stephen Barclay
I am keen to work with my hon. Friend to encourage Southport and other trusts to recycle equipment. I know from my family’s experience that it causes significant frustration when people see hospitals not collecting perfectly good medical equipment that could be recycled. I am keen to work with him and with trusts to ensure that we learn from that.
Stephen Barclay
I commend my hon. Friend for his excellent report for the Centre for Policy Studies, which highlights the opportunities provided by technology. I was at a Scan4Safety event last night, looking at how barcodes are being used at six trusts, and at how that could be expanded to deliver 4:1 efficiency savings and improve patient care through the safety it offers.
Laura Smith (Crewe and Nantwich) (Lab)
Does the Minister believe that the practice of cutting funding to hospitals that miss A&E targets helps to improve the patient experience at those hospitals? Will he agree to meet me to discuss how this issue has affected Leighton hospital, which serves my constituents?
Stephen Barclay
The hon. Lady may have missed our recent announcement of significant additional funding, ahead of winter pressure, to assist hospitals. As the Secretary of State announced, the extra £20.5 billion real-terms increase is part of a wider commitment to support our hospitals.
Mr David Lammy (Tottenham) (Lab)
Jack Adcock’s death was a tragedy, but why did the General Medical Council spend £30,000 on getting Dr Hadiza Bawa-Garba struck off, even though she had already faced the consequences of her mistakes in court? Does the Minister think that the GMC needs to sort its act out and that Charlie Massey should resign?
Stephen Barclay
As the right hon. Gentleman will be aware, Professor Norman Williams looked at the circumstances of this case and produced a report on it for the Government. As a part of that, we are looking at a number of factors.
David Tredinnick (Bosworth) (Con)
Is the Minister aware that in terms of value for money and efficiency, the Government of India’s integrated health Ministry has half a million ayurvedic doctors and a quarter of a million homeopathic doctors? At a clinic I visited recently in Karnataka province, four fifths of the patients who would have normally gone to see a western doctor were treated by those local doctors. Will he build links with the Indian Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy?
Stephen Barclay
I pay tribute to my hon. Friend for the longevity and sincerity of his campaigning on these issues. He draws attention to the wider point of how patients presenting with multiple and complex conditions need to be treated in multiple ways, and what he refers to is a part of that wider discussion.
Dr Philippa Whitford (Central Ayrshire) (SNP)
NHS England is being ripped off to the tune of £230 million a year as the price of some off-patent drugs and non-standard preparations, or specials, have been hiked up hundreds of times, for example to over £1,000 for a bottle of pain-relieving mouthwash. In Scotland, specials remain in-house to keep the price down, but a year and a half on from the Health Service Medical Supplies (Costs) Act 2017, why have the Government not used its powers to stop this drug racketeering?
Stephen Barclay
The hon. Lady, very astutely and correctly, identifies the issue, which is how we ensure value for money from specials. Indeed, I commend The Times for highlighting a number of these issues. We are looking at this area. As we commit an extra £20 billion in funding to the NHS, our commitment is to ensure that we derive value for money from that investment. That applies to specials, too.
Dr Whitford
The healthcare market in NHS England is estimated to cost £5 billion to £10 billion a year and involves 2.5 million nursing hours a week being wasted on non-clinical paperwork. Does the Minister not recognise that this is the biggest inefficiency? Will he commit to reversing the disastrous marketisation of NHS England?
Stephen Barclay
Again, the hon. Lady draws attention to my work on driving productivity improvements within the system, which looks at a range of efficiencies such as sending texts and emails, dealing with missed appointments and the use of green energy. We can implement a whole range of initiatives as a part of that agenda.
Steve Double (St Austell and Newquay) (Con)
As the first port of call for patients with often minor ailments, community pharmacists can really help to improve the efficiency of the NHS by taking pressure off GPs. What plans do the Government have to support and enhance the role of community pharmacists?
Stephen Barclay
My hon. Friend is right to draw attention to the valuable role played by pharmacies. This is part of a wider education campaign within the NHS and increased access to clinicians, such as through 111, is another component of that. We want to ensure that rather than people’s first port of call being a GP, they access the NHS and pharmacies at the appropriate time.
Justin Madders (Ellesmere Port and Neston) (Lab)
At the end of the last financial year, trusts owed the Department a staggering £11 billion. NHS providers say that this is locking some trusts into
“a vicious circle of inevitable failure”,
and the King’s Fund says that there is no prospect of them ever repaying. Trusts with the biggest debts are forced to pay the highest levels of interest. How can the Minister expect trusts to be efficient when they are paying an interest rate of 6% on debts to his Department?
Stephen Barclay
As it happens, I will be at an event with NHS providers—chief execs—this evening, when I am sure that this will be one of a number of issues that we will discuss. The hon. Gentleman is right to draw attention to the very high private finance initiative costs that many trusts face due to contracts signed under the previous Labour Government. That is a real pressure faced by many trusts.
Richard Benyon (Newbury) (Con)
The Minister for Health (Stephen Barclay)
The planned temporary overnight closure of the Princess Royal Hospital’s A&E in Telford is necessary to ensure that patients continue to receive safe care. The Shrewsbury and Telford Hospital NHS Trust is working closely with colleagues in neighbouring provider trusts and the ambulance service to develop plans for key clinical pathways to minimise the impact.
Emma Reynolds
The proposed closure of Telford A&E would pile even more pressure on New Cross Hospital in my constituency. If the Government will not step in to stop the closure, as it sounds is the case from the Minister’s answer, will they give New Cross the resources it needs to recruit upfront the nurses, doctors and other staff they need so that patients do not have to suffer longer delays?
Stephen Barclay
The current modelling suggests that about 11 ambulances will be diverted from the Shrewsbury and Telford Hospital NHS Trust between the hours of 10 pm and 8 am during closure. Of the patients who go to Wolverhampton, any admitted as in-patients will return to Shrewsbury and Telford and any who are discharged will be discharged from Wolverhampton.
Lucy Allan (Telford) (Con)
The chief executive of Royal Wolverhampton NHS Trust says that the closure at Telford is the result of bad planning and could have been prevented. Does the Minister agree it is wholly unacceptable that my constituents’ safety should be put at risk by a preventable closure that is the result of bad planning by management, and will he do all he can to ensure that the hospital management have the help they need to properly run our hospital and properly plan for the needs of our community?
Stephen Barclay
First, may I pay tribute to my hon. Friend, who has campaigned assiduously on behalf of her constituents? She has lobbied me and the Secretary of State and made her case very powerfully to NHS leaders. There has been progress: three additional consultants have been hired and attempts made to recruit middle-ranking doctors to the trust, including from neighbouring trusts. We are making a significant capital investment in the Shrewsbury and Telford Hospital NHS Trust, and these changes must be seen in the light of that.
Sir Edward Leigh (Gainsborough) (Con)
The Minister for Health (Stephen Barclay)
My hon. Friend is right to highlight this. The Secretary of State was at the trust last week, and I visited earlier in the year. There is a specific range of actions, including partnership with Sherwood Forest Hospitals NHS Foundation Trust; advanced clinical practitioner courses, which started in June; £1.8 million of capital to support improvements to patient flow; and a frailty pilot at Lincoln. There is an intensive programme of work with this trust, because we recognise my hon. Friend’s concerns.
Liz McInnes (Heywood and Middleton) (Lab)
Stephen Barclay
As the hon. Lady will know, since 2010, the number of paramedics has increased by more than 30% and the pay band has been increased from band 5 to band 6. She will also know from the excellent work of Lord Carter that there was significant variation between ambulance services and a significant opportunity to make savings that can be reinvested in ambulances by addressing differences in sickness rates, “hear and treat” and “see and treat” rates and other variables. We have also committed additional funding for new ambulances, including in the north-west, which will be in place by this winter.
Boris Johnson (Uxbridge and South Ruislip) (Con)
Mike Amesbury (Weaver Vale) (Lab)
Stephen Barclay
I am not aware of the specific details of that, but I am happy to meet the hon. Gentleman to discuss it if he has particular concerns he wishes to raise.
Mr Marcus Fysh (Yeovil) (Con)
Toby Perkins (Chesterfield) (Lab)
The service from the East Midlands Ambulance Service NHS Trust has been a considerable disappointment for many of my constituents in recent months. When I met them about the service, they told me that on a huge number of occasions they have ambulances sat waiting outside accident and emergency departments, rather than getting to the next call. What more can the Government do to make sure we get these A&Es cleared?
Stephen Barclay
The hon. Gentleman is right to say that we need to improve those handovers. We have improvement programmes in place at 11 hospital sites in the east midlands, alongside which we are making a £4.9 million investment in 37 new ambulances. Part of this is also about the length of stay and addressing the pathway.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
The Mid Yorkshire Hospitals Trust is proposing to close our midwife-led maternity unit, telling me that, while it is safe, unless it has 500 births a year, it is not value for money. Is that a new national standard for midwife maternity units, because if so it would close 90% of free-standing units? Will a Minister meet me on this matter, because it is unfair on local parents, and, frankly, we are sick and tired of losing services from our towns?
Stephen Barclay
I am happy to meet the right hon. Lady and to discuss the matter further.
Tom Pursglove (Corby) (Con)
I am extremely concerned about the case of Logan, a young boy in my constituency who requires round-the-clock care and the handling of his case by Corby clinical commissioning group. I have written to the Minister raising concerns about this case, but is he willing to meet me and Logan’s parents, Darren and Wendy, to talk about how this could perhaps be resolved and to apply any pressure that he can, because, as a family, they should be making memories at the moment, not battling local NHS bureaucracy?
Stephanie Peacock (Barnsley East) (Lab)
Will the Government write off the debts of Yorkshire hospitals so that extra money invested can go into patient care?
Stephen Barclay
As the Secretary of State set out, we are making a significant funding commitment to the NHS—the extra £20 billion—but that is not conditional on writing off debt.
Robert Courts (Witney) (Con)
Will the Minister please provide an update to the House on work to ensure that we train more GPs for England, particularly for west Oxfordshire?
Rachel Maclean (Redditch) (Con)
I am hearing deeply concerning reports about ambulance waits outside Worcestershire Acute Hospitals NHS Trust, and the Minister is aware of these concerns. We welcome the capital funding that is going into this trust, but will he meet me to discuss what more can be done to improve patient handover, which is concerning for my constituents?
Stephen Barclay
As my hon. Friend says, there is significant capital investment into Worcestershire, as well as a major programme of improvements addressing variation in ambulances, but of course I am also happy to meet her to discuss the matter.
Daniel Zeichner (Cambridge) (Lab)
Last week, the chief executive of the Association of the British Pharmaceutical Industry warned that even associate membership of the European Medicines Agency would not do for our life sciences sector, so can the Secretary of State tell us how much longer we will have to wait and how much more we will have to pay for new medicines if we are outside the European medicines market?
Clinical Waste Incineration
Steve Barclay Excerpts(5 years, 7 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Jonathan Ashworth (Leicester South) (Lab/Co-op)
(Urgent Question): To ask the Secretary of State for Health and Social Care to update the House on clinical waste incineration across the NHS.
The Minister for Health (Stephen Barclay)
Yesterday evening, the hon. Gentleman, in a point of order, repeated claims made by Healthcare Environmental Services regarding incineration capacity, and the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) raised a point of order on the capability of Mitie to deliver waste management services for the NHS and on TUPE arrangements for staff employed by Healthcare Environmental Services. I would like to clarify why the statement that there is sufficient incinerator capacity is correct, and why the claims made by the company, which is currently subject to criminal investigation, should not be taken at face value, as appears to have been the case yesterday.
With regard to incinerator capacity, there have been quotes from Environment Agency and NHS Improvement officials, cited in the Health Service Journal in May and August 2018, suggesting that there is a shortage of clinical waste incinerator capacity. By the time of my statement on 9 October, far more due diligence had been conducted on the claims made by Healthcare Environmental Services. Analysis carried out by NHSI identified 2,269 tonnes of incinerator capacity in October. The trusts served by Healthcare Environmental Services produced 595 tonnes. The analysis shows that there is sufficient incinerator capacity for clinical waste and that the statement made to the House was therefore correct. The issue is whether HES is willing to pay for that capacity. The fact that Mitie has secured 1,000 tonnes of incinerator capacity demonstrates that it is available.
The right hon. Member for Normanton, Pontefract and Castleford questioned whether Mitie was capable of delivering waste management for the NHS. The Mitie contract was put in place rapidly on 5 October to ensure continuity of service following trusts exercising their step-in and then termination rights to end their contracts with Healthcare Environmental Services. Over that weekend, Mitie visited the NHS sites to understand their business needs and the frequency of collections required, and responded immediately to trusts where waste needed to be collected. It also located bins on those sites so that the collections could start. Putting a new contract in place so quickly clearly means that there needs to be a phased approach to Mitie providing 100% of the service previously provided by Healthcare Environmental Services.
Mitie is working closely with NHSI to ensure that the needs of the trusts are being met, and regular collection schedules are in place at sufficient levels to maintain all patient services safely. The trusts also have additional contingency storage in place on site, with the waste being collected correctly stored so that the NHS can contain its services. This storage contingency will remain in place until Mitie meets 100% of the waste collection frequency required by the trusts. There is no risk to public safety through the action taken by the trusts.
As regards TUPE, Mitie has written to Healthcare Environmental Services and its legal representatives to request complete information, to assess the situation with regard to the potential transferring of employees and to minimise disruption for those employees. Mitie has also set up a dedicated helpline and email address to support Healthcare Environmental Services staff at this uncertain time.
It continues to be the case that there is no risk to public safety through the action taken by these trusts and that all NHS trusts have been able to continue to provide operations in line with meeting our key objective.
Jonathan Ashworth
All we are asking for from the Minister is full transparency. Last week, he told the House with great confidence that
“the suggestion in some quarters that this is an issue of a lack of capacity is simply not valid.”—[Official Report, 9 October 2018; Vol. 647, c. 39.]
Subsequently, we read in the Health Service Journal, as he mentioned, that NHS Improvement had concerns about capacity back in August and acknowledged that there were “national market capacity issues”. He has told us today that due diligence has been done since then. Why did he decide not to reveal in his statement last week that concerns were raised with him back in August? Was he aware when he came to the House and made his statement that these concerns had been raised in August? He tells us that extra due diligence has been carried out. Can he explain what that extra due diligence actually is?
The Minister has tried to reassure us again today that there are no public health implications to the measures that have been put in place since HES lost these contracts. Can he therefore explain his view of the various allegations currently circulating on social media, with photos and videos suggesting that waste is not being picked up from a health centre in Keighley, that hospital staff in Leeds are shifting waste in inappropriate overalls, that hazardous waste at Dewsbury is being stored in inappropriate shipping containers and that up to 15 trusts across Yorkshire are storing waste illegally? Has he checked each and every one of those allegations? Can he tell us what his inquiries have revealed about them? If he has not looked into each and every one of those allegations, why not?
Can the Minister assure us that incineration sites to which tonnes of waste from HES facilities are now taken are big enough to safely manage this waste, that the drivers transporting the waste are suitably qualified and that the incinerators now being used are designed to deal with hazardous waste? Last week, I asked him to give us a cast-iron guarantee that there is no risk to public health at any of those sites, or where the waste is currently being incinerated. Will he give us that absolute guarantee today? All we want from the Minister is complete and utter transparency. We have not had that so far.
Stephen Barclay
The hon. Gentleman seems to be spending a lot of time on social media and not looking at the data on what is being done. There was a time when Opposition Members were used to the complexity of legal agreements and contracts and would have understood that mobilising 17 NHS contracts and maintaining NHS operations on those sites requires a significant amount of work. It takes time for Mitie to mobilise that contract—[Interruption.] If he gives me a moment, I will address directly the different concerns that he raised.
The hon. Gentleman’s first concern was that a statement given in October, with up-to-date information based on the work done leading up to it, was in some way incorrect because it did not pick up on early discussions within NHSI, which was only notified on 31 July. Obviously the concerns raised by HES about a lack of incinerators needed to be looked into. Having been looked into, those concerns were found not to have merit. The evidence for that is the fact that the new supplier, Mitie, has been able to secure 1,000 tonnes of incinerator capacity. If the hon. Gentleman’s central charge is correct, he will need to explain how Mitie has been able to find available incineration capacity when HES was unable to do so.
The hon. Gentleman asked when I was notified. I was not notified of the internal discussions among officials in August; I was not dealing with the issue at that point. The issue is what the House was informed of when the statement was made.
On the allegations on social media, I have not checked every single tweet that the hon. Gentleman has looked at, but the fact is that of the 17 trusts, three have had the stock of waste on their sites cleared and 12 are due to have theirs cleared by the end of the week, with two remaining, as Mitie mobilises from around 80% of service delivery now to 100% in the coming weeks.
The right hon. Member for Normanton, Pontefract and Castleford has made some legitimate points about TUPE and about Mitie scaling up, which I am sure she will come on to. Those points were not addressed, surprisingly, in the shadow Secretary of State’s comments, but I am happy to pick them up in due course. One of the advantages of Mitie is that it should deliver greater resilience, because it is not looking to deliver all the elements of the contract in the way that HES is. It is bringing in other firms, such as logistics suppliers and disposal firms, so there will be greater resilience in the contract, but we can address any specific concerns that the right hon. Lady has, given her constituency interest.
Rebecca Pow (Taunton Deane) (Con)
I thank the Minister for his clear words. I remember just how emotive the whole issue of incineration can be, because I was a news reporter at the time of the foot and mouth and BSE sagas, and it is something that worries the public. Can I have an assurance from the Minister that there is an industry-wide agreement that there is enough capacity everywhere to deal with incineration?
Stephen Barclay
My hon. Friend is right to identify the concern there has been following comments on social media and certain media reports about incineration and the nature of this clinical waste. As I said in my statement, I am happy to confirm that there is sufficient capacity, as Mitie has demonstrated. It is worth reminding the House that just 1.1% of the waste under discussion is anatomical, and many of the media reports do not reflect that.
Neil Gray (Airdrie and Shotts) (SNP)
The business concerned, Healthcare Environmental, is based in Shotts in my constituency. Waste incineration—where and how it happens—is always an emotive and controversial issue, and it is imperative that we get strong regulation right. But it appears that the UK Government have influenced—shall we say?—that regulation to deal with an issue that the company claims was contained and it had a plan to deal with.
Can the Minister confirm whether special dispensation has been granted to a municipal site in Slough that apparently does not have a licence to deal with hazardous waste, to incinerate this waste in a way that would otherwise have been inappropriate? Can he confirm that the waste has been handled by unlicensed individuals and been moved against normal regulations? Can he clarify what role the Cabinet Office has had in this issue and whether the UK Government have had any relationship with Healthcare Environmental’s competitor, Stericycle? The focus last week was on Healthcare Environmental, and now the focus appears to turn to Government actions. With 400 jobs under threat across the UK and 150 in my constituency, is it not time we had an independent inquiry into this whole mess?
Stephen Barclay
The hon. Gentleman is right to recognise that there is a significant impact in Scotland, given the services that HES supplies, and it is worth reminding the House that HES is still trading and clearing waste from a number of NHS sites. However, given that it has been subject to a series of actions by the Environment Agency and is subject to a criminal investigation, it is worth treating HES’s claims with a degree of caution.
The Environment Agency is of course an independent agency, so it is for the Environment Agency to look at how waste is being processed, and a strict legal framework applies to that. The specific concern about Slough has not been raised with me, but I am happy to take that away and write to the hon. Gentleman.
The Cabinet Office has been in active discussion with the NHS and the Department of Health and Social Care, as have Scottish officials, who have worked very constructively with officials in England. This has been seen as an issue that affects Scotland as well as England, and it is one on which officials have worked collaboratively.
Mrs Anne Main (St Albans) (Con)
Can my hon. Friend reassure patients who might be concerned that their operations have been delayed in any way, shape or form by this whole fiasco that at no point were any members of the public put at risk by the treatment or non-treatment of this particular sort of clinical waste?
Stephen Barclay
My hon. Friend is absolutely right to focus on that. The key risk in respect of this supplier was that the NHS’s ability to continue to perform operations would be affected if it could not clear its clinical waste. I am happy to reassure her that all 17 trusts affected have been able to maintain their services, which ultimately is the key issue for patients and our constituents.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
Can the Minister confirm that the staff are being offered TUPE transfers? I have heard from constituents who have been told that they are not, and clearly it is completely unfair for staff to be stuck in limbo like this. Can he say whether he has considered breaking up the contract and treating incineration separately, what the additional cost of the new contract might be and which part of the NHS is paying?
Stephen Barclay
The right hon. Lady raises an important point. I am happy to meet her to discuss these issues, given her constituency interest. I understand that she met members of staff on Friday. I very much urge HES employees who are listening to the debate to phone Mitie’s dedicated helpline and provide their details. The key issue is that Mitie has requested information from HES that it has not provided. To assess whether TUPE legally applies and the work patterns and issues of the staff involved, Mitie relies on HES providing information that, to date, has not been provided. The key issues in giving reassurance to staff are for them to contact the helpline and for HES to provide the information requested.
Julian Knight (Solihull) (Con)
I congratulate the Minister on the measured way in which he is dealing with this unpleasant situation. Can he confirm that the Environment Agency will suspend HES’s remaining permits if enforcement action does not return it to full compliance?
Stephen Barclay
My hon. Friend will be aware that the Environment Agency is an independent body, so it will be for the Environment Agency to reach a decision on whether such a suspension should be raised. I can reassure the House that the issue is subject to great scrutiny at present and that the Environment Agency is looking at it very closely.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
It seems to me that there are two ways of looking at such issues. Factoring in numbers, statistics and logic is one way and leads to one conclusion, but when we think about human decency and human dignity it becomes something entirely different. The public’s confidence in the methodology is absolutely paramount at this stage. First, does the Minister recognise that, and secondly, can he tell me what he is doing to restore that public confidence?
Stephen Barclay
The hon. Gentleman is absolutely right, and I very much recognise that. The emotive nature of the topic and the way in which some of the headlines have been written do cause alarm. We are being very strategic. First, we are ensuring that our key priority, which is continuity of service in hospitals, is maintained. Secondly, we are ensuring that a supplier is mobilised as quickly as possible. He will recognise that to mobilise a supplier over so many contracts, where those contracts are not uniform—there are different legal provisions in them—is a complex issue. Thirdly, where there is an interregnum with regard to contingencies and waste that needs to be stored on site, we are ensuring that that is done in the safest way possible and that the waste is then cleared at the earliest opportunity.
Andrew Jones (Harrogate and Knaresborough) (Con)
I thank my hon. Friend for the reassurance that there is enough capacity in the incineration system to deal with this issue, but will he confirm that the delays caused by Healthcare Environmental Services have not had an impact on the capacity for patients to receive the treatment that they need?
Stephen Barclay
My hon. Friend is absolutely right that the issues we have experienced with the supplier have not affected the NHS’s ability to maintain its service. That has been our key objective throughout, and that continues to be the case.
John Howell (Henley) (Con)
Will the Minister confirm that, after the NHS trusts had terminated their contracts with HES, a new contract was given almost immediately?
Stephen Barclay
My hon. Friend is absolutely right. One of the key issues was to have alternative provision in place as quickly as possible so that we were not in the situation of waste being stored on site beyond the absolute minimum. It is a tribute to officials in the Department and in the NHS, the Department for Environment, Food and Rural Affairs and elsewhere that a quite complex set of legal arrangements has been mobilised in such a short period to ensure that services are maintained.
Mr Marcus Jones (Nuneaton) (Con)
While the backlog is being cleared, will my hon. Friend confirm that any waste will be kept in a secure and safe fashion? Will he also be more exact about when he thinks the backlog of waste currently in the system will be cleared?
Stephen Barclay
There are two different components to that. There is the waste on sites, such as at Normanton, where HES has allowed a degree of waste to be stored, but I think my hon. Friend’s question is driving at the waste on hospital sites. As I said in my statement—[Interruption.] If the hon. Member for Leicester South (Jonathan Ashworth) waits for the reply, he will hear that the stock on those sites is being cleared. Perhaps he has been busy checking social media again. The bulk of the sites will be cleared by the end of the week; there will be two remaining beyond this week. We are very much focusing on that issue.
Mr Philip Hollobone (Kettering) (Con)
Will the Minister confirm that, had he not taken action, the failure of Healthcare Environmental Services to dispose of the clinical waste properly would have presented a serious risk of clinical waste backing up in hospitals and other healthcare facilities? Owing to his taking effective action in a timely way, that has been avoided and healthcare delivery has not been interrupted.
Stephen Barclay
I thank my hon. Friend for that question. There has very much been a Government-wide effort to ensure that waste did not build up, for the reason he mentions—the ability of the NHS to maintain its services and continue to operate if clinical waste could not be removed from the site. There is a varying degree of contingency capacity on different sites, so certain hospital sites would quite quickly exhaust that capacity if it was not cleared. That is why, as my hon. Friend the Member for Henley (John Howell) said, the ability to mobilise the contract quickly was so important.
Eddie Hughes (Walsall North) (Con)
Will the Minister assure the House that good governance will be in place to ensure that the new provider can dispose of the waste very safely?
Stephen Barclay
I am very happy to give my hon. Friend that assurance. There are lessons to be learned from the HES contract, and I am keen that we do so, but as I commented earlier, the contract with Mitie—through the use of different logistics firms and different waste sites—will actually build greater resilience into the arrangements for clearing clinical waste.
Tom Pursglove (Corby) (Con)
Building on that point, will my hon. Friend ensure that there is an overarching review of local processes to make sure that failings of this sort by a contractor cannot happen again anywhere in the country?
Stephen Barclay
I am very happy to give my hon. Friend that reassurance. It is important, where a supplier has got into such difficulties, that we learn the lessons and ensure that they are part of contract procurement moving forward.
Clinical Waste Update
Steve Barclay Excerpts(5 years, 7 months ago)
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The Minister for Health (Stephen Barclay)
This statement is to update the House on an issue concerning clinical waste collection and disposal for hospitals and other public services.
On 31 July, the Environment Agency notified central Government of an issue concerning clinical waste collection and disposal for hospitals and other public services provided by the company, Healthcare Environmental Services (HES). In this instance, the primary concern was that too much waste was being held in a number of waste storage and treatment sites by a contractor, Healthcare Environment Services (HES). While the waste was stored securely, it was not being processed and disposed of within the correct regulatory timescales. At no point has there been an impact on public health or any delay to the ability of the NHS to carry out operations.
The Department of Health and Social Care, DEFRA, the Cabinet Office, NHS England, NHS Improvement and the Environment Agency have worked together to resolve these issues. From the outset, the Government’s priority have been to ensure measures were put in place so that trusts could continue operating as normal should there be any disruption to waste collection and disposal. This objective has been achieved. The Department of Health and Social Care has worked with the NHS to help trusts put these contingency plans in place. A major part of these contingency plans concerned contractual discussions with HES and other providers which were commercially sensitive.
Following the Environment Agency’s issuing of a partial closure to HES’s Normanton site, on 3 October the regulator, NHS Improvement, issued a letter to HES to advise them that they had concerns in respect of services provided to trusts. To give HES an opportunity to set out how it was complying with its legal and contractual obligations, NHSI gave HES 48 hours to provide evidence that they were operating within legal and contractual parameters and set out a number of threshold levels. NHSI concluded that HES failed to demonstrate that they were operating within their contractual limits. Consequently, 15 NHS trusts served termination notices to HES formally to terminate their contracts at 4 pm on Sunday 7 October. In parallel, the Department of Health and Social Care, the Cabinet Office, NHS Improvement and the affected trusts have negotiated a new contract with Mitie to step in and replace this service. This contract was enacted, following the termination of the contract with HES, and Mitie have been fully operational across all affected trust sites from Monday morning.
Throughout, the Government’s priority have been to ensure measures were put in in place so that NHS trusts can continue operating as normal. No gap in service provision has been reported and we are working to ensure that this remains the case.
The Environment Agency are taking enforcement action against HES to clear the excess waste from their sites and bring the company back into compliance with their permits. As part of this enforcement activity, the Environment Agency have partially suspended the company’s permit at their Normanton site. This will prevent HES from accepting any more incinerator-only waste, as the company focuses on clearing the backlog of waste on-site. The Environment Agency are also progressing with enforcement action at the other non-compliant sites. This includes following up the first enforcement notice for the HES Newcastle site. If the site does not become compliant, the likely next stage is a partial suspension to prevent the acceptance of incinerator-only waste at Newcastle. It is the company’s responsibility to clear its sites and operate legally.
I am updating the House on this situation now, given that new contracts have been signed following the conclusion of the commercially sensitive process. I can confirm that NHS services continue to operate as normal. We are ensuring that there are contingency plans in place in case of any disruption, and that there is absolutely no risk to the health of patients or the wider public. The Government are working with the Environment Agency and NHS to ensure lessons are learnt, and we are reviewing how contracts will be awarded in the future.
[HCWS972]
Baby Loss Awareness Week
Steve Barclay Excerpts(5 years, 7 months ago)
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The Minister for Health (Stephen Barclay)
May I join colleagues across the House in paying tribute to my hon. Friend the Member for Eddisbury (Antoinette Sandbach) for securing this debate on Baby Loss Awareness Week? It is particularly appropriate, as today marks the start of the 2018 campaign. How we reduce the numbers of baby losses is an issue that unites the House, as has been very much reflected in the tenor of this evening’s debate. May I also say to my hon. Friend the Member for Colchester (Will Quince) that I am sure that all in the Chamber will be thinking of Robert and him on Friday, as he marks that particularly poignant fourth anniversary?
My hon. Friend the Member for Eddisbury raised a number of important points in her speech, including about the national bereavement care pathway and the ongoing investigations at the three hospitals in England and Wales. I will address those shortly. She is right to recognise the higher profile that this issue has received in recent years, this being the third such debate in the last three years. That is very much testament to the work of the all-party group on baby loss and in particular my hon. Friends the Members for Eddisbury, for Colchester and for Banbury (Victoria Prentis), who is not in her place, the hon. Member for Washington and Sunderland West (Mrs Hodgson), to whom my opposite number correctly paid tribute and who very much moved the House in a previous debate, and the hon. Member for North Ayrshire and Arran (Patricia Gibson), who quite rightly spoke of Kenneth, who is very much in her thoughts and reflects much of the work that she has done in this place. The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) also made the point very well that this issue affects the family as a whole, including grandparents.
Martin Docherty-Hughes (West Dunbartonshire) (SNP)
I join the Minister in congratulating all the Members who have brought this issue to the Floor of the House today and especially the hon. Member for Eddisbury (Antoinette Sandbach) on securing the debate. The Minister has talked about the family, and we have heard much about the emotional journey for mothers and fathers who experience loss. We are living now in a more equal society, in which more lesbian women are becoming mothers, and they, too, experience loss through the death of a baby or young child. Will he ensure that that is reflected in the opportunities to learn about the lived experience of mothers, to which my hon. and good Friend the Member for North Ayrshire and Arran (Patricia Gibson) referred, whether they have a husband or a wife?
Stephen Barclay
The hon. Gentleman makes a valid point. He will have noticed that my colleague the Minister for Women and Equalities was in the Chamber for part of the debate, and I am sure that those sentiments are very much reflected in the work that she is doing. I am very happy to work with him to ensure that the Government’s approach takes those points on board.
Before coming to the wider areas of progress and considering what still needs to be done to deliver the improvements that we all want to see, I will address some of the specific comments made by Members across the House. My hon. Friend the Member for Colchester rightly mentioned the inconsistency between trusts. I understand that Sands is asking for the national bereavement care pathway to be included in the CQC’s inspection framework for maternity. I am happy to write to the CQC to request that this becomes part of the inspection regime. I think that can build on the point my hon. Friend the Member for Eddisbury made about recent progress in Medway.
My hon. Friend the Member for Colchester also suggested a training module for midwives on bereavement. Again, I am happy to write to Professor Ian Cummings, the chief executive of Health Education England, on that point and to share the correspondence with the all-party parliamentary group. One of the objectives of the pregnancy loss review is to recommend options to improve maternity care practice for parents who experience baby loss, so that is part of that work.
My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who so often brings her clinical expertise to debates, raised the issue of travel costs. The Patient Advice and Liaison Service can advise on eligibility for schemes, as this tends to be specific to individual trusts, but it can apply in certain instances, particularly when linked to benefit entitlement.
My hon. Friend the Member for Gloucester (Richard Graham), who is no longer in his place, mentioned the important work of the hospital chaplaincy, and I think that Members on both sides of the House recognise the support that chaplains can offer following baby loss. Indeed, the bereavement care pathway guidance recommends offering parents contact with the chaplaincy team, so the role of the chaplaincy will be given greater visibility as the pathway is rolled out across more trusts.
The hon. Member for Ellesmere Port and Neston (Justin Madders) rightly mentioned midwife numbers. We recognise that the workforce do face pressure, as is reflected in the 25% increase in the number of midwifery training places that the Government are committed to. Indeed, numbers have increased in each of the last four years. But he makes a valid point and we are focused on dealing with the workforce pressures.
As a number of Members have recognised, the Government have a clear ambition to halve the rates of stillbirths, neonatal and maternal deaths and brain injuries that occur during or soon after birth by 2025, and to achieve at least a 20% reduction in these rates by 2020. Since the launch of the national maternity ambition in 2015, the Government have introduced a range of evidence-based interventions to support maternity and neonatal services, under the leadership of the maternity safety champions, who are responsible for promoting safety in their organisations.
I am pleased to report that we remain on course to achieve our 2020 ambition. The stillbirth rate in England fell from 5.1 to 4.1 per 1,000 births between 2010 and 2017, representing a decrease of almost 20%, which equates to 827 fewer stillbirths. We currently have the lowest stillbirth rate on record. The neonatal mortality rate also fell from 2.9 to 2.8 per 1,000 live births between 2010 and 2016. Many Members will be aware that multiple pregnancies are at greater risk of perinatal death, so I welcome the findings in a recent MBRRACE-UK report showing that the stillbirth rate for UK twins almost halved between 2014 and 2016, with a fall of 44%. In addition, neonatal deaths among UK twins has dropped by 30%.
There are areas of progress, but as my hon. Friend the Member for Colchester rightly said, part of the focus of today’s debate is on the areas where we need to improve, not just on the areas where there has been progress. One key area relates to ethnic minority groups, where we know stillbirth and neonatal mortality rates are increasing rather than decreasing. The Government continue to work with others to develop and implement policies to tackle such inequalities. This is an area on which we would be very happy to work with the APPG. It is an issue of concern to Members on all sides of the House.
A number of Members raised the role of the Healthcare Safety Investigation Branch and the importance of identifying where there are lessons to be learned. My hon. Friend the Member for Sleaford and North Hykeham is right that clinicians must be free to speak up where mistakes have been made. Indeed, the former Secretary of State championed that in his work on patient safety. It is also why we are improving investigations into term stillbirths. There is a role for the Royal College of Obstetricians and Gynaecologists in terms of the Each Baby Counts programme. Considerable work is under way, part of which, as my hon. Friend the Member for Eddisbury recognised, is on ensuring that in respect of the investigations at the specific hospitals she mentioned the appropriate lessons are learned. She will appreciate that, as they are live investigations, I cannot comment on them in detail.
Evidence demonstrates that women who have a midwife-led continuity model of care are less likely to suffer baby loss. In March, the Secretary of State pledged that most women will receive such care throughout pregnancy, labour and birth by 2021, with 20%, or about 130,000 women, benefiting by 2019. This will help to bolster maternity safety and further improve care standards.
It is positive to see the impact that many initiatives can have on reducing baby loss, but the Government recognise the need to improve the care bereaved families experience. That is why the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Minister with responsibility for maternity care, recently announced full funding of £106,000 to the charity Sands to continue the roll-out of the national bereavement care pathway. I hope that reassures my hon. Friend the Member for Eddisbury that the value of the care pathway is very much recognised within Government. As my hon. Friend mentioned, this initiative has seen a positive response from parents and medical professionals, with 77% of professionals saying bereavement care has improved.
On pregnancy loss and the pregnancy loss review, which my Department commissioned earlier this year, the review has been considering the question of whether legislation should provide new rights to bereaved parents to register pre-24-week pregnancy loss, as well as investigating the impact of such losses on families and how care can be improved for parents who experience it. That review is currently scheduled to be completed in the new year. A number of very important points on that pre-24-week period were raised.
The Department of Health and Social Care and the Ministry of Justice have been consulting with coroners, patients’ groups and charities to consider the role of the coroner in relation to stillbirths. This is about ensuring that bereaved parents are given a full account of the events leading up to the loss of their baby and that important lessons are learned. The hon. Member for Nottingham South (Lilian Greenwood) in particular made a point on the role of coroners in an intervention. This work will continue over the coming months.
In conclusion, progress is being made. I think that was recognised in a number of the speeches this evening, particularly in respect of: the commitment to fund in full the national roll-out of the bereavement care pathway in 2018-19, for which guidance and resources have been released today; the ongoing pregnancy loss review, which is due to report in early 2019; the work being done by the Department of Health and Social Care and the Ministry of Justice regarding the role of the coroner in investigating stillbirths; the progression of the private Member’s Bill, which will have its Third Reading on 26 October, promoted by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) on those last two issues; and the recent passage of the Parental Bereavement (Leave and Pay) Act 2018, mentioned by a number of Members, through the work of my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake).
I would like to close by making it clear that the Government are actively listening to concerns on this issue. This issue unites the House. On behalf of the Government, I very much look forward to working with the APPG, and Members across the House, to ensure that the progress we have seen in recent years continues, so that we can all tackle the most appalling loss that the families we represent can face.
Dangerous Waste and Body Parts Disposal: NHS
Steve Barclay Excerpts(5 years, 7 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Jonathan Ashworth (Leicester South) (Lab/Co-op)
(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the accumulation of hundreds of tonnes of dangerous waste.
The Minister for Health (Stephen Barclay)
As I set out in the written statement published this morning, on 31 July the Environment Agency notified central Government of an issue concerning clinical waste disposal. The primary concern was that too much waste was being held by a contractor, Healthcare Environment Services, in a number of waste storage and treatment sites. This included waste collected from hospitals and other public services. Although the waste was stored securely, it was not being disposed of within the correct regulatory timescales.
The Department of Health and Social Care, the NHS, the Department for Environment, Food and Rural Affairs, the Environment Agency and the Cabinet Office have worked together to resolve the issues. Our priority throughout has been to ensure that proper measures were put in place to enable trusts to continue to operate as normal. A major part of the contingency plans concerned commercially sensitive contractual discussions with HES and other providers.
Following the Environment Agency’s partial suspension of HES’s Normanton site, which came into force on 3 October 2018, NHS Improvement wrote to HES to raise its concerns. NHSI gave HES an opportunity to set out how it was complying with its legal and contractual obligations; HES failed to provide that assurance. As a result, 15 NHS trusts served contract termination notices on Sunday 7 October. As part of our contingency arrangements, we ran a tender process with the clinical waste sector before awarding a new contract to Mitie. As contracts with HES were terminated over the weekend, Mitie stepped in and, from Monday morning, provided continuing waste collection and incineration across all of these organisations.
In September, officials from the Department of Health and Social Care visited each of the major trauma centres affected and confirmed that waste was being stored correctly and that contingency plans were in place.
In addition, visits have been undertaken to each of the sites by the Environment Agency this weekend and this week, alongside earlier visits. The Environment Agency is continuing its enforcement action against HES. This includes ensuring that excess waste is cleared from non-compliant sites. The Government are working with the Environment Agency and the NHS to ensure that lessons are learned, and we are reviewing how contracts will be awarded in the future. I have updated the House on this situation today as new contracts were implemented on Sunday following the conclusion of this commercially sensitive process. Our priority throughout has been to ensure that measures were put in place so that the NHS could continue operating as normal. No gap in service provision has been reported and we are working to ensure that that remains the case.
Jonathan Ashworth
This is an absolutely horrific scandal. A private contractor has failed in its responsibilities to a quite staggering degree. Three hundred and fifty tonnes of waste, including human body parts, amputated limbs, infectious fluid and substances of cancer, was left effectively stockpiled and not safely disposed of; it is an absolute scandal. How on earth did we get to this? If the Environment Agency first raised concerns in March, if Ministers were formally informed in July, and if Cobra was convened and chaired by the Health Secretary last month—by the way, I really think that the Health Secretary should be answering questions at the Dispatch Box today—why was the decision taken not to inform Parliament and the public sooner? Given that concerns were raised in March, why did the NHS not intervene earlier? In fact, concerns were raised with NHS England last year, so can the Minister tell us what monitoring, if any, of the HES contract was put in place by the Department and Ministers?
The Minister referred to 15 trusts having terminated their contracts. The Health Service Journal reported that up to 50 trusts were affected. Will he clarify what the status is of the contracts with the remaining 35 trusts? Where Mitie has taken over the contracts, what regulation and oversight of Mitie and its subcontractors is now in place? Is he confident that there are enough incinerators across the country to dispose of waste in a timely manner?
Let me turn now to the public health implications. At the Normanton site, we were told that waste is now in refrigerators, but where was it before if not in refrigerators? Hospitals are now using temporary containers, but questions have been raised about the public safety implications of those containers. Can the Minister give us an absolute guarantee that those containers are safe and that there is no public health risk?
We are picking up the pieces, yet again, of another disastrous procurement of an outsourced contract by a private firm going wrong. What plans are now in place to ensure that something like this never happens again?
Stephen Barclay
Let me pick up on the various points that the hon. Gentleman has raised. On when Parliament was told, as I said in my statement, the partial suspension notice was served on the company on 3 October and new contracts were put in place over the weekend. This is, therefore, the first opportunity, following what had been commercially sensitive negotiations, to notify the House. It is also right to remind Members that the key strategic objective throughout has been to maintain operations at NHS hospitals to ensure that clinical waste is being collected. That strategic objective has been maintained at all times.
The hon. Gentleman asked a number of other questions, including whether there is enough incinerator capacity in the system. The answer to that is, yes there is. There are 24 incinerators. The Department for Environment, Food and Rural Affairs estimates that there is more than 30,000 tonnes of spare capacity in the system, and that there is significant capacity over and above that required by HES to perform its contract, so I can be very clear to the House that, moving forward, there is sufficient incinerator capacity.
The hon. Gentleman used some inflammatory language. It is worth reminding the House that just 1.1% of this clinical waste is anatomical, so some of the media headlines are slightly out of step with reality. The partial suspension that has been served on Normanton is solely in respect of the incinerator; it does not apply to the other sites under HES contractual arrangements with the trust.
The hon. Gentleman asked whether the waste was being secured safely. The answer is yes; the Environment Agency has been inspecting the situation. The issue is the overstorage of waste, not that the waste is not being stored in a safe manner. [Interruption.] Well, that is the legal remit of the Environment Agency, which is an independent body. It is right that the law is applied; the hon. Gentleman may not like to apply the law, but this is the legal process. Officials from the Department of Health have been to the major trauma sites to see the contingency plans at first hand, and the storage and capacity is in place at those sites.
The reality is that there was a contractual arrangement with a supplier that stored the waste correctly, but stored too much of it. The Environment Agency is enforcing against that. We have put in place contingency plans within the trusts and set up alternative provision in the form of a contract with Mitie. The key strategic objective of ensuring that NHS operations continue has been secured.
Dr Sarah Wollaston (Totnes) (Con)
I thank the Minister for the prompt action that he has taken since being notified of this situation. Will he reassure people in the community and in community settings that this issue will not affect their safety?
Stephen Barclay
The Chair of the Health Committee raises an important point regarding residents in the areas where the sites are located, and I see the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) in her place. The Environment Agency has confirmed that the waste is being stored safely; it is the amount of waste that is the issue. Many of our constituents are waiting for operations on these sites and will want reassurance that those operations can continue in a timely fashion. That has been a key focus of the Department, and I pay tribute to the work of officials in the NHS, the Department of Health, DEFRA and the Environment Agency, who have ensured that that strategic objective has been maintained.
Dr Philippa Whitford (Central Ayrshire) (SNP)
This situation does indeed sound graphic and horrific. Equally, I recognise that much of this waste will be cytotoxic, including drugs and syringes. We are talking about materials that are contaminated with faeces, infectious material and blood. We are discussing five sites across England. HES also has two sites in Scotland, both of which have been checked and do not have overstorage.
We hear that HES was served with 13 warning notices and two compliance notices over the past year. If that information was not accelerated up to the Department of Health, should it have been? HES says that it has been reporting its issue with incineration to regulators for quite a long time, yet the Minister says that there is no issue of capacity, so could not the Department have responded by directing HES to all this extra incineration capacity that apparently exists? As more local authorities are going towards zero-waste and incinerating material that would have been in landfill, the pressure will increase. There is probably ageing infrastructure and a need to expand, so do the Government plan a waste incineration strategy?
Stephen Barclay
The hon. Lady is absolutely right that HES has sites in Scotland; I think there are four. The Scottish Environment Protection Agency has been conducting regular site inspections and we are looking closely at the situation there—not least regarding the movement of waste from one site to another. However, she is correct that we are not aware of any specific issues at those sites.
The primary purpose of enforcement notices has been to encourage the company back into compliance. That has been the focus of the Environment Agency. The reason for the partial suspension in Normanton has been the unwillingness of the company to respond. Some notices are for what might be seen as relatively minor issues such as documentation, but obviously some relate to the overstorage on these sites.
Rebecca Pow (Taunton Deane) (Con)
I am pleased that new contracts have been signed and enforcement action has been taken—and quickly—but what is really important are the lessons learned, so will the Minister expand on that? While this is a sensitive matter—understandably, it evokes all kinds of concerns for the public—will the Minister assure us that there has been no risk to patients at any time or indeed to the wider public from this most concerning of issues?
Stephen Barclay
I am grateful to my hon. Friend for her question, and I am happy to give her constituents an assurance that there has been no risk to patients at any point during this time. As for lessons learned, clearly we will need to look at some of the lessons, particularly what triggers a breach of contract. A series of contracts were held by a wide number of trusts with the supplier, and it is important that we look at what the notification periods are, what the monitoring and enforcement processes are, and what powers there are under the terms of the contract to ensure that the company is acting as it should.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
We still do not have the basic facts about what medical waste is being held at the Normanton site, how far over the environmental limits it currently is, and what the timetable is for compliance. Perhaps the Minister would share that information with us. Does he not accept that it is a basic principle that, when dealing with any kind of public health or environmental health risk or incident, proper, full, factual information is provided to the public and the community at the earliest possible opportunity? You do not hide behind contractual negotiations. Does he accept that there is nothing in the contract negotiations that would have prevented him or the Health Secretary from providing some basic facts about those risks much, much earlier than today?
Stephen Barclay
On the split to which the right hon. Lady referred between clinical waste and other waste at the Normanton site—she rightly focused on that for her constituents—just under a third of the flow of waste to the site is clinical. Just over two thirds, in my understanding, is non-clinical. It is not the case that all the waste on the Normanton site is clinical waste. As I have mentioned, some media reports about what the term “clinical waste” constitutes are slightly different from the reality.
As for notification, I set that out in my written ministerial statement and in my comments today. The key focus is on maintaining the continuity of operations and service within the NHS trusts so that we are not in a position where clinical waste cannot be cleared from them. That is the focus, and that is why, given the commercial negotiations and the contingency arrangements that have been put in place, we came to the House today, and not at an earlier point.
Mr Philip Hollobone (Kettering) (Con)
In the end, the system has worked. There has been no back-up of clinical waste in hospitals—it has just been overstored in these sites. However, it is worrying, if it is true, that 13 warning notices and two compliance notices were issued to the company. Does the Minister think that he should be alerted earlier by the Environment Agency if this sort of thing happens in future?
Stephen Barclay
My hon. Friend makes a valid point about the lessons to be learned from this. Part of what I would expect to look at as we move forward are questions about when the NHS was first made aware of this and what powers are available to enforce at an earlier stage. As I have mentioned, enforcement notices cover a spectrum of risk. Some of those risks are more technical in nature than others, so while there have been 13 notices, their enforcement encompasses a range of severity.
Liz Kendall (Leicester West) (Lab)
According to its most recent accounts, HES made a gross profit of over £15 million last year. What financial penalty will it suffer because of its gross incompetence?
Stephen Barclay
The first financial penalty it has suffered is the prompt action we took over the weekend, with 15 NHS trusts cancelling those contracts and moving across. There is a clear financial penalty in that loss of business. As for fines, that is a matter of legal process, through the Environment Agency, in the normal way. That is not an NHS matter. The focus for the NHS is on maintaining continuity of service.
Rachel Maclean (Redditch) (Con)
The Minister will be aware that my constituents want to be assured that their operations in Redditch and Worcester will be able to continue as normal. Can he give them that assurance?
Mary Creagh (Wakefield) (Lab)
The Government like to talk tough on waste criminals, but here we have waste criminals storing 350 tonnes of clinical waste illegally—five times the amount to be compliant—at their site in Normanton, and despite the Minister being told about this on 31 July, neither the local MP nor constituents were informed. Cobra was informed. A criminal investigation is now under way into the company. Can he ensure that not a single acute hospital trust will lose one penny piece as a result of this criminal negligence?
Stephen Barclay
The hon. Lady raises several points. On the 350 tonnes of waste, I clarified the flow of that waste in my comments to the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) and I said that not all of it is clinical. I was not personally told on 31 July. I set out in my written statement when the NHS and then Ministers were told.
The question about whether there is any cost to NHS trusts is a very valid one for all constituency MPs who wish to understand the situation. The contingency cost—for example, from the additional capacity being put in place at trusts—will be borne centrally by the NHS family, and the cost of processing clinical waste will be borne by NHS trusts, as it has been to date.
Kevin Foster (Torbay) (Con)
I welcome the action the Minister has taken to terminate the contracts with this company, given its clear breaches and failure to deliver what it said it would. In his statement, he referred to the capacity for clinical waste incineration. Can he give us further detail about how he satisfied himself that there is capacity in each region? Clearly, these are specialist facilities, and having to transport waste could have a knock-on effect.
Stephen Barclay
I should clarify that it is not me personally who has terminated these contracts. These contracts with HES are held by the trusts themselves, and therefore it is a decision taken by those trusts.
As I said earlier, there is significant additional capacity within the incinerator landscape to process the waste generated by this contract, and therefore the suggestion in some quarters that this is an issue of a lack of capacity is simply not valid. To be clear, HES produces 595 tonnes of waste a month that goes to incineration, and the NHS identified 2,269 tonnes of incineration capacity, so reports that there is a lack of capacity in the market are not valid.
Wes Streeting (Ilford North) (Lab)
I learned from the Health Service Journal that Barking, Havering and Redbridge University Hospitals NHS Trust was one of those affected. It is totally unacceptable that clearly one of Ministers’ objectives was to cover things up for as long as possible to save their own blushes because of the failure of a Government contractor. Members of this House should not learn of such events from the media. We should hear it from Ministers via the Dispatch Box or the relevant Select Committee—or there is such a thing as email.
Ministers have announced that £1 million of contingency funding is to be made available to support trusts affected. Will that be met from existing departmental budgets, or will money be allocated by the Treasury? Further to the point made by my hon. Friend the Member for Leicester West (Liz Kendall), surely it should be the failing contractor that coughs up £1 million, if not more. It should not come from taxpayers.
Stephen Barclay
We all learn things on a regular basis from the HSJ, but it seems misplaced to suggest that the hon. Gentleman should have been told about this when we were ensuring continuity of service and putting in place alternative arrangements to ensure that operations could continue at Barking and other hospitals. I have already addressed that point.
As I said, some of the cost—the contingency cost—will be absorbed centrally. The normal cost of clearing clinical waste was borne by the trusts before and will continue to be borne by the trusts.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I welcome the fact that there has been no gap in service provision and no public health risk and that the Minister has confirmed that nobody’s operation has been delayed because of this build-up of clinical waste, but it is still concerning that the contract was not properly delivered. How long has he given the site to return to compliance and what action is he taking to supervise the remaining contracts?
Stephen Barclay
The key issue for performance under the contracts is what, contractually, the legal requirements on HES are and whether those contractual terms have been breached. Part of the lessons learned is to look at whether contractual enforcement powers are sufficient. In terms of moving forward in respect of the other HES sites, that will depend on the contracts that the supplier has and whether it is in breach of those contracts or of enforcement action from the Environment Agency. To date, the Environment Agency has served one partial suspension, on the Normanton site. As I referred to, the Environment Agency was at the other site over the weekend. This is an area of significant scrutiny, but it will be for the Environment Agency to determine whether the company is not in compliance with its permits.
Maria Eagle (Garston and Halewood) (Lab)
So far, the Minister appears to have been far more interested in contractual arrangements than in public accountability. Can he explain how come Cobra has met and this House has not been informed of it? This House should be informed about Cobra meetings as soon as possible after they are finished.
Stephen Barclay
I am not sure about the exact protocols for when Cobra should and should not be reported, but given that it usually deals with highly confidential matters, I would have thought that not every issue should necessarily be reported in the first instance. We have been focused not on contractual niceties, but on ensuring that the NHS continues to deliver first-class services. As I referred to earlier, this is the first opportunity we have had following the conference recess to notify the House, following the contractual arrangements being made.
Tom Pursglove (Corby) (Con)
Will my hon. Friend confirm that the backlog of waste will be dealt with speedily, in accordance with the requirements of the law and with appropriate supervision?
Stephen Barclay
I very much share my hon. Friend’s desire for the backlog to be cleared as speedily as possible. As I referred to a moment ago, this is an area of scrutiny for the Environment Agency, and it is important that the company complies with its legal requirements and ensures that the level of waste is in line with its permits as soon as possible.
Nic Dakin (Scunthorpe) (Lab)
Hospitals such as Scunthorpe general cannot run effectively without the safe and secure disposal of clinical waste, which is exactly why it is important that the Minister has made the comments that he has today. Northern Lincolnshire and Goole trust quite properly put in place local contingencies, because obviously it could not rely on things being sorted out. It now looks as though contingencies are sorted nationally, so can he be very clear that local trusts will not face a penny more of extra costs as a result?
Stephen Barclay
The hon. Gentleman raises a fair point, and I want to be clear about the distinction. Additional cost arising from the contingency arrangement—for example, putting in place extra storage on the trust’s sites—will not be an additional cost on the trust. I hope that that will reassure him, although I do not want to suggest to him that there will be no financial impact on trusts, because the requirement to clear clinical waste sits with the trust. That is why the trusts themselves had contracts with the supplier. The ongoing arrangements are likely to mean some increased cost, as the new supplier comes on board. That will fall to the trust, but not the contingency element.
Integrated Care
Steve Barclay Excerpts(5 years, 8 months ago)
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Dr Wollaston
Coming back to why integrated care does not happen, there are many deeply ingrained structural divides. Since the inception of the NHS 70 years ago, we have had a system that is free at the point of use for the NHS, but means-tested for social care. That presents an extraordinary hurdle when systems are trying to join up. It is not just that; it is different contractual arrangements and working practices. Good integration comes down to individuals and teams being prepared to work together, but it often feels like they are working together to achieve integration despite the systems around them, not because of them.
We need a system where everybody is focused on helping the right kind of integration to take place, and we need to go back and look at that fundamental structural divide between the systems. I ask the Minister to look again at the joint report, “Long-term funding of adult social care”, because that is an important issue that goes to the heart of the barriers to joining up services. It is about contractual differences, different legal accountabilities and payment systems that work against the pooling of budgets, and financial pressures within the NHS.
A certain amount of financial pressure can encourage systems to come together to pool their arrangements and provide a more efficient service, but as the Minister will know, when the elastic is stretched too tight and the financial strain becomes critical, we see the opposite—systems are forced apart. I have seen that happen in my area, where people suddenly feel that they have to retreat to their organisational silos to fulfil their legal obligations. There is no doubt that, for the process to work effectively, we need the right amount of funding—and sufficient funding—and tweaks to the legislative arrangements to allow people to come together, so it does not feel as if they are working together despite the system.
The Minister for Health (Stephen Barclay)
Thank you, Dame Cheryl, it is a pleasure once again to serve under your chairmanship. I join the hon. Member for Ellesmere Port and Neston (Justin Madders) in paying tribute to my hon. Friend the Member for Totnes (Dr Wollaston) as Chair of the Health and Social Care Committee, and to all the members of the Committee, for a very good report and for raising important issues regularly on behalf of the NHS and the wider health fraternity.
As a country, we are living longer, which clearly is to be celebrated. However, it means that people live with multiple long-term and more complex conditions. For the NHS to continue to deliver high-quality care as it has done for the last 70 years, it is increasingly important for NHS services to work closely with social care. We got a flavour of that from a number of the remarks made in the debate.
I very much welcome the Committee’s conclusion that fears that integration might lead to privatisation are unfounded. Indeed, the Chair of the Committee said,
“The evidence to our inquiry was that ACOs,”—
now referred to as integrated care partnerships—
“and other efforts to integrate health systems and social care, will not extend the scope of NHS privatisation and may effectively do the opposite.”
That relates to some of the points I will make on pre-legislative scrutiny and points to the value of the work done by the Health and Social Care Committee to provide a cross-party view of proposals, which has allowed us to address some of the myths built up in the past. The Committee has done the House a service by slaying some of those misconceptions.
Dr Wollaston
I thank the Minister for referring to my remarks, but does he accept that the Committee went on to say that we felt the issue of privatisation should be put beyond doubt in legislation?
Stephen Barclay
The Chair of the Committee is absolutely right. We have always been clear that integration is about improving patient care, and that the NHS will remain free at the point of delivery.
A number of key points arose from the debate. Remarks were made about ensuring that the service is patient-centred, and concerns were expressed about whether transformation funding may be diluted. I will come to pre-legislative scrutiny, to which the Chair of the Committee referred, and primary legislation.
The hon. Member for Central Ayrshire (Dr Whitford) raised concerns about private firms and the role of GP-led organisations. The hon. Member for Stockton South (Dr Williams) and my hon. Friend the Member for South West Bedfordshire (Andrew Selous) referred to focusing on prevention and taking a wider needs-based approach. A number of Members referred to information sharing, leadership and the lessons from Liverpool Community Health NHS Trust—the hon. Member for West Lancashire (Rosie Cooper) performed a great service by highlighting that. That is reflected in the work I have commissioned from Tom Kark on the fit-and-proper test.
[Ms Karen Buck in the Chair]
Members focused on the need for a patient-centred approach, which the hon. Member for Kingston upon Hull North (Diana Johnson) emphasised in her intervention. In our approach to integrated care, we seek to build a healthcare solution around what is best for the patient and, in the words of the Chair of the Committee, why it matters to patients. That is very much the Government’s intention.
As the Committee Chair said, financial pressure can both incentivise and impede integration. She will be aware that the up to £20 billion a year that will go into the NHS as part of the Prime Minister’s commitment to funding the service will be front-loaded—there is more in the first two years in recognition of the importance of the double-running to which the Chair of the Committee referred. According to past National Audit Office reports, there have been a number of cross-party initiatives under successive Governments. As she and other Committee members set out, sustainability trumps transformation, which is one of the key challenges for the NHS family as it brings forward its 10-year plan. For the first two years, an extra £4.1 billion will go in, with front-loading of 3.6% compared with the average over the five years of 3.4%, which very much reflects the concerns she articulated.
The tone of the debate was one of broad consensus, and we will realise that first by asking the NHS itself to lead on the legislative changes required. The NHS will bring forward its proposals through the 10-year plan. We will not mandate, but let local areas decide what fits their locality best. That will be informed, for example, by health and wellbeing boards. I met the chair of the Lancashire health and wellbeing board yesterday—that speaks to the concern raised about the need for Health Ministers to take a wider approach rather than, as the hon. Member for Stockton South said, looking purely at the NHS element. We are looking much more widely and bringing in local authorities. Indeed, the Department’s name has changed, and the work of the Care Minister reflects the wider integration in our approach.
Although we welcome the Committee’s work on testing the NHS proposals as part of the long-term plan, we will wait for the NHS proposals before confirming the specific pre-legislative scrutiny arrangements. I hope the approach I have taken in discussions with members of the Committee underscores the importance I place on working in a cross-party way. The approach we have set out very much reflects that.
Dr Whitford
Can the Minister commit to looking at legislative change? It is fine for designs to come from the NHS, but if those designs are based on existing barriers, they will not reach their full potential.
Stephen Barclay
The Prime Minister has set out that it will be for the NHS itself to come forward, rather than for the Government to specify legislative change in a top-down way. As part of the long-term plan, the NHS will determine what can be done within the existing framework and whether change is needed. That will flow from the work that comes forward later in the autumn from Simon Stevens, Ian Dalton and others in the NHS, who are best placed to lead.
Dr Paul Williams
In the short time the Minister has left, will he will address the invitation he was given categorically to rule out integrated care providers being private sector organisations? Does he accept that the language he has used—he said the NHS will continue to be free at the point of use—increases concerns about private sector provision?
Ms Karen Buck (in the Chair)
Order. Minister, in responding, will you be mindful of the time and the need to leave the Chair of the Select Committee a couple of minutes to respond?
Stephen Barclay
Indeed I will, Ms Buck.
I draw the hon. Gentleman’s attention to the Committee report, which states:
“There is also little appetite from within the private sector itself to be the sole provider of…contracts…There are several reasons why the prospect of a private provider holding an ACO contract is unlikely…Integrated care partnerships between NHS bodies looking to use the contract to form a large integrated care provider would have an advantage over non-statutory providers that are less likely to have experience of managing the same scope of services”.
The hon. Gentleman himself referred to the desire not to rule out GP-led organisations, which are independent. He also mentioned GP-led organisations becoming NHS bodies. I am happy to meet him to explore exactly what he means. It is not the Government’s intention for private firms to run ICP contracts.
Dr Whitford
The Minister says that that is unlikely and that private firms do not want to run such contracts, but we are talking about a 10-year plan. Does he therefore recognise that it should be ruled out to give surety? We do not want another Hinchingbrooke, where a private company takes a contract on and an entire area faces a private provider walking away from an integrated care partnership.
Stephen Barclay
These arguments were explored at the Committee, which addressed that question. The fear of privatisation has been overplayed.
We are taking a people-centred approach and letting the NHS lead on shaping it. We have said we will respond to the points the NHS raises and act on them, but integration will enable services holistically to deliver better care for patients—as the hon. Member for Strangford (Jim Shannon) said, that includes better data sharing—and put the needs of patients front and centre. That is reflected in the report and in the cross-party consensus on how we want to take integration forward.
Nurse Training
Steve Barclay Excerpts(5 years, 8 months ago)
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The Minister for Health (Stephen Barclay)
I pay tribute to my hon. Friend the Member for South Dorset (Richard Drax) for his assiduous campaigning on behalf of his constituents and for securing the debate. Its importance is reflected by the fact that my hon. and learned Friend the Solicitor General and the Under-Secretary of State for Wales, my hon. Friend the Member for Eastleigh (Mims Davies), were in the Chamber to listen to the points that my hon. Friend the Member for South Dorset raised.
My hon. Friend spoke passionately about the training of nurses in England and the pivotal role of training in ensuring that we have a workforce to deliver first-class services in the NHS. With a budget in which two thirds of our spend goes, quite rightly, on our workforce, the importance of that workforce is absolutely critical. Indeed, that was reflected by my right hon. Friend the Secretary of State when he set out his three key priorities for the NHS after taking over that post. He particularly emphasised the importance of the workforce within those priorities.
Nick Thomas-Symonds (Torfaen) (Lab)
I apologise, Mr Deputy Speaker, for not being here at the start of the debate. A number of constituents who have contacted me are clearly concerned about the fact that the demand for nurses is not quite being matched by recruitment at the moment, particularly in the areas of learning disability and mental health. What specifically can the Government do, in addition to what they are doing, to really focus on those two specialist areas?
Stephen Barclay
The hon. Gentleman makes a valid point. I think that we all recognise that learning disability has traditionally been one of those areas in which it is harder to recruit, compared with, for example, midwifery, where the number of applicants to training places is a lot higher. I do recognise that there is an issue.
Let me give just one example of what we are doing. When we looked at the situation in postgraduate training, particularly for more mature applicants, one of the issues was the possible impact on the area of learning disability. That was why we put in place golden hellos, with a budget of up to £10 million, to provide an incentive for applicants taking the postgraduate route into nursing to go particularly into the areas of learning disability, mental health or district nursing. That is one of the measures that we put in place to address the hon. Gentleman’s very valid point, but I am not suggesting that that alone fully deals with the issues that we need to look at, and we are paying very close attention to the situation.
I now turn to some of the specifics in the very well-put speech made by my hon. Friend the Member for South Dorset. He quite rightly highlighted the cost of agency staff within the NHS, suggesting that there could be more than half a billion pounds of savings if those staff were permanent. It is fair to say that the cost of agency staff is a key issue, and he was very fair in putting on record that Dorset HealthCare has reduced its agency staff spend over the past three years from £12 million to £4 million. That has not happened by accident. This is something that the Government have been prioritising nationally, and I pay tribute to the NHS Improvement’s work in placing a cap on agency spend in 2015, which very much addresses his point. Indeed, we have seen agency costs come down nationally by £1.2 billion since 2015, which shows the progress made under this Government.
My hon. Friend also understandably put on record his concerns about local beds moving from Portland Community Hospital to Weymouth. He mentioned the chief executive, Ron Shields. As he will be aware, Ron Shields has pointed out that twice as many patients using those Portland Community Hospital beds come from Weymouth, 6 miles away in my hon. Friend’s constituency, than from Portland. Clearly there is a benefit for patients if twice as many of those using the hospital are from Weymouth and the beds move to Weymouth. On average, four beds are taken by islanders, so it is a relatively small number, but I appreciate that it is an issue for those on the island.
However, there is a wider patient benefit, particularly for those from Weymouth. There is a benefit for all patients who move to Weymouth, because they can access a wider suite of services, including the services of a consultant with specialist expertise in elderly medicine, as part of a wider range of professional support. It is also important to emphasise to my hon. Friend’s constituents that the site is not closing; services are being reconfigured to reflect changes in the way in which healthcare is delivered. Again, that is happening nationally. As patients present with more complex needs and multiple conditions, we need to look at how we address that and how we deliver care more in the community, which is what patients want and is better for them, as well as how we better embrace technology, which is a key priority of my right hon. Friend the Secretary of State.
Richard Drax
I am listening carefully to my hon. Friend’s reply. He is absolutely right: Mr Shields instinctively would like to keep community hospitals. In rural parts of the country, and certainly in South Dorset, with an ever-increasing number of elderly people moving there, there is very much a feeling of, “Where are they all going to be?” Experience in the past has shown that the best place for an elderly person to recover is near their home in a cosy community hospital. The system works. As the beds go for the reasons I have explained—Mr Shields rightly had no choice but to do it, and it is true that the hospital will remain open—those fears will not just disappear overnight.
Stephen Barclay
My hon. Friend is right that being cared for close to home is in patients’ interests. I would actually go a step further and say that most patients want to be cared for and supported at home, if possible, because they are more likely to be mobile and to get up to make a cup of tea in their familiar surroundings. If that is not possible, they want to be in a community setting, but in that community setting it is better that they have access to a wider suite of services, including a consultant specialist, so that we can avoid the 43% of patients on average who are currently being treated in probably the most expensive part of the NHS family, the acute setting, where they are, for example, at greater risk of infection, notwithstanding the fact that since 2010, under this Government, the rate of hospital infections has halved. Even so, there can be muscle deterioration, or what one clinician called “PJ paralysis”. Staying in acute hospitals is often not in the best interests of an elderly patient, so treating them at home or in a community setting with the right support to reduce their length of stay is in their interests.
The crux of my hon. Friend’s remarks was a challenge as to what the Government are doing to tackle the need to recruit more nurses as we face a growing demographic. I remind him, as he is well aware, that the Prime Minister has committed to more funding for the NHS—a £20 billion-a-year additional funding package. There is a commitment to staff in the NHS through “Agenda for Change”, and the Government are introducing an increase in pay for nurses.
We are looking at additional pathways such as the nursing associate programme, which my hon. Friend referenced. There are 5,000 places this year and 7,500 next year. The programme enables people who perhaps thought they would not have the opportunity to be a nurse and were trapped in a particular role to have a ladder of opportunity and to move from roles such as healthcare assistant into that of nursing associate, with the option of then progressing into a nurse role.
We need to look at the nursing degree apprenticeship, and we are using the apprenticeship levy that the Government have introduced through the tireless work of the Minister for Apprenticeships and Skills. Again, that provides a great opportunity for people to progress within the NHS. We should also look at the measures the Prime Minister has taken on tier 2 visas—removing the cap—and recognise that attracting talent from overseas is an important part of addressing the concerns about recruitment raised by my hon. Friend.
We are looking at measures to give giving staff greater flexibility, such as through e-rostering, and using technology to provide greater certainty. There are also measures in relation to returning to work. Since 2014, 4,800 nurses have started on the return to practice programme to bring that talent back into the NHS. The Government are taking a whole suite of measures, because we recognise that there is a need for more nurses, exactly as my hon. Friend said.
Richard Drax
The Minister is being most kind and generous in giving way. Will the bursary return? I would have thought that the bursary was more likely to attract home-grown talent. I am not saying that nurses from abroad are a bad thing, because they are not—they all do a wonderful job—but we are always trying to train our own. If the Minister brought back the bursary, I would have thought that was more likely to attract people from this country.
Stephen Barclay
The problem with the bursary scheme was that it involved a cap on the number of places, so a massive number of people who wanted to be nurses were rejected and denied the life chance of being a nurse. The removal of the cap has allowed us to increase the number by 25%—an additional 5,000 places. That is 5,000 people who will have the opportunity to train as a nurse who did not have such an opportunity under the bursary scheme. It is also means that while they are training as a nurse, they will have a higher maintenance grant through the Student Loans Company than they did previously under the bursary system. I appreciate the concerns raised about the bursary, but this Government are all for giving people the opportunity to progress, life chances and the opportunity to increase their skills. The removal of the bursary scheme has allowed us to offer more people the opportunity to become a nurse, rather than fewer, as was the case under the bursary.
I do not want to choke off the opportunity for someone who aspires to be a nurse, but we should recognise that people want to progress at different stages of their lives. That is why the right option for some is to be a nursing associate. Some people may want to stay as a nursing associate, some may want to progress to being a nurse, and some may want to do a nursing degree apprenticeship. It is important that we offer the flexibility that people increasingly want in society so that they can pursue their careers at different rates and at different times.
The Government have taken a whole range of measures. I mentioned the “Agenda for Change” pay award, under which the pay of a healthcare assistant will go up by 26%, or nearly £4,000, over the next three years. A nurse with between three and four years’ experience will receive a 25% increase, which is more than £6,000 over three years, and a band 6 paramedic with between three and four years’ experience will have a £4,000 rise over three years. Again, as my hon. Friend mentioned, that recognises the hugely valuable contribution that staff make to the NHS.
I touched on the fact that we are looking at specific areas in which we recognise that there are issues and referred to the postgraduate golden hellos as a way of targeting recruitment. I have also said that we have lifted the cap on tier 2 visas. Under the existing arrangement, 40% of tier 2 visas were actually going to the NHS, but we have none the less lifted the cap.
I pay tribute to my hon. Friend’s campaigning on behalf of South Dorset. He is always assiduous in speaking to Ministers and raising concerns on his constituents’ behalf. We are repurposing services, but we are moving beds to where there will be better support, and these are some of the changes that will deliver an NHS fit for the future. I am happy to continue discussions with him so that we ensure the NHS continues to serve his constituents with first-class care.
Question put and agreed to.
Derbyshire CCGs’ Finances
Steve Barclay Excerpts(5 years, 8 months ago)
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The Minister for Health (Stephen Barclay)
It is a pleasure to serve once again under your chairmanship, Sir Christopher. I congratulate the hon. Member for High Peak (Ruth George) on securing this important debate. She has effectively put on record her concerns about the financial challenge faced by the Derbyshire CCGs.
The hon. Lady is right to recognise that the Government are committing more money to the NHS. That is why the Prime Minister has announced a funding increase of, on average, 3.4% each year to 2023-24. The NHS budget will therefore increase by more than £20 billion a year compared with today. Alongside that, it is also right for NHS England, the independent organisation that allocates funding, to question the efficiency of CCGs, in particular by comparison with other CCGs, looking for what efficiencies can be found. Indeed, the four CCGs in Derbyshire have already identified £39 million of savings, against our target which is 3% of their overall budgets. Significant progress has therefore been made to meet the challenge set by NHS England.
Ruth George
Part of that £39 million is £5 million of decommissioning, which includes those voluntary services, so they are now having to be reviewed. That £39 million in cuts is not good news—it is pretty bad news for the NHS, as I have set out.
Stephen Barclay
I was just about to come on to the voluntary sector, because that is where the hon. Lady’s speech started, but in her remarks she talked about the four CCGs coming together as part of the “efficiencies of scale”—her precise phrase—so I shall come back to the voluntary sector later.
Toby Perkins
I am probably in the position of largely agreeing with the Minister. I remember that, back in 2010, we had the Derbyshire primary care trust, but then the Lansley reforms came in, broke up the PCT and turned it into five different organisations in North Derbyshire. Can he imagine how galling it is for us to hear that those organisations, which went from a very strong financial position back in 2010, are now in utter financial chaos, so the Government are going to undo the Lansley reforms and to get those economies of scale that we were telling them about back in 2010?
Stephen Barclay
There seems to be a slight contradiction in the hon. Gentleman’s argument. He is arguing that, on the one hand, the financial position was strong in 2016—I remind him simply that the Lansley reforms were in 2012—and, on the other hand, that the issue is with the Lansley reforms.
Toby Perkins
May I make a point of clarification, because the Minister is misquoting me? I said that the financial position was strong in 2010, not in 2016.
Stephen Barclay
In which case, I refer to the remarks of the hon. Member for High Peak, who did say that the CCGs’ position was strong in 2016. The hon. Gentleman is therefore seeking to disagree with his hon. Friend rather than with me.
Lee Rowley
Every Member present who represents a Derbyshire constituency is concerned about the actions of the CCG, particularly the implication for the voluntary sector. That was outlined by the three Conservatives and two of the Labour Members, either by speaking or by being present. The challenge is that, if we contextualise this debate in a not-quite-accurate framework, we misunderstand why we are here in the first place and therefore how we get out of here. That is why the cuts narrative from the hon. Member for High Peak is unhelpful in the extreme.
Stephen Barclay
My hon. Friend is absolutely right. I was coming on to address the allocations for the four CCGs, which I am told by NHS England are above where NHS England independently sets the target. To be precise, according to NHS England, in the case of the Derbyshire CCGs, North Derbyshire is 6.2% above its target allocation, while Erewash is 2.31%, Hardwick 1.92% and Southern Derbyshire 0.25% above the target.
My hon. Friend is absolutely right that it is about how effectively the money is spent. He is also right that, within that search for efficiencies, alongside the additional £20 billion of funding that the Government have allocated, we need to address the point that the hon. Lady correctly raised about the value for money of many of the voluntary services. He correctly identified that there is a cross-party consensus and indeed concern that the value for money of those services should not be the first line of call when seeking efficiencies.
As part of that discussion, the CCG has confirmed that, having looked into this, three of the voluntary services will be protected. The south Derbyshire, Chesterfield and north Derbyshire Cruse Bereavement Care and the Stroke Association support services will be protected. The hon. Lady made a point about the value for money of night services costing £34,000, which within a £51 million target is a very small sum, and the New Mills where she cited the £2.26 per hour. That is exactly the discussion that the CCG is having. It is unhelpful to scare local people ahead of those consultations, because those decisions have not been taken. One of the benefits of the hon. Lady calling this debate is that it allows Members from across the House to put on record their support for voluntary services as part of looking at the legitimate question of where the efficiencies from economies of scale can be identified across the CCGs.
The Government are allocating more funding to the NHS, but they are looking at areas that are above their target allocation to ask, “Where are the inefficiencies and how do we spend that?” As part of asking taxpayers to contribute £20 billion more a year to the NHS, it is right that we ask how effectively that money is spent and that we ensure that we drive efficiencies.
The hon. Lady did not mention this, but it is pertinent that there is funding to Derbyshire in other forms: for example, the £12.5 million that has recently been provided for the four CCGs to spend on increasing theatre capacity at the Royal Derby Hospital. Again, that is part of enabling the CCGs to drive efficiencies. Some £40 million of sustainability and transformation partnership capital bids are yet to be approved. There are additional funding bids in the Department, NHS Improvement and NHS England as part of driving those efficiencies that the CCGs are being asked to deliver.
Alongside that is the vanguard programme—the CCGs agreed a business case in January 2018 to spend £1.1 million to continue to fund significant elements of the Wellbeing Erewash programme. My hon. Friend the Member for Erewash (Maggie Throup) has been an extremely strong champion of the benefits and importance of the programme in Erewash in her interactions with ministerial colleagues. The CCGs have introduced a range of financial measures to improve their financial position, including development of an efficiency strategy and a move to joint leadership arrangements, to which the hon. Member for High Peak referred. Closer functional working across the four CCGs in Derbyshire will help, but so will the additional capital that is being sought and innovation to work more efficiently through programmes such as vanguard.
On the voluntary sector, which was the meat of the hon. Lady’s remarks, it is important to stress that decisions have not been taken and that a consultation process is under way. The CCGs will have those discussions with local stakeholders. It is important to be clear that before taking any final funding decisions on services through the voluntary and communities sector, that further round of engagement and consultation with the local communities, local authorities, patients, GPs and other stakeholders will take place.
Nigel Mills
What we desperately do not want is a short-term saving made to fix a short-term problem. Bringing those services back in 18 months’ time when the much-welcome increased funding is available will not happen, because the volunteers and the organisations will have gone. Can there be any kind of downpayment on that future funding, or some slight relaxing of the annual deficit calculations, just to get us through the gap so that we do not do something now that we regret in 18 months’ time?
Stephen Barclay
To some extent, that is already happening in the form of the £45 million of the deficit that is being absorbed by NHS England, but part of the NHS England consultation is assessing where the CCGs are against their target allocation—it is part of the consideration of the £40 million of capital bids for Derbyshire and part of the £12.5 million that was secured for the improvements at Derby county. It is also part of other issues in the NHS such as length of stay—43% of patients in acute hospitals do not clinically need to be there and would be better served in the community, which is where those value for money assessments need to play a part.
Ruth George
Why are 84 community beds, and my beds in Buxton at Fenton ward, which are the only place where patients in acute care can be transferred, being cut?
Stephen Barclay
Again, local clinical decisions are taken by the CCGs, which is the correct approach. This goes to the heart of the point raised by my hon. Friend the Member for North East Derbyshire. Driving efficiency as part of spending more on the NHS is not about not having any change. Indeed, the hon. Lady previously expressed concerns about the specialist dementia inpatient beds in her constituency. Again, those are specific commissioning decisions—it is inappropriate for a Minister to comment on specific decisions—but, although I understand her concerns in relation to the number of specialist dementia inpatient beds, I am assured that the model implemented in Derbyshire reflects the changing needs and approaches to providing health and care for dementia patients. Patients benefit from structured care in their homes or in an adult care-led facility—that model is supported by clinicians.
We need to differentiate legitimate questions from NHS England in an area that is receiving more than its target allocation and where there are opportunities for efficiency, while taking on board the concerns raised by my hon. Friend the for Amber Valley about the transition as the additional Government funding comes, and while allowing the NHS in Derbyshire to change. Just as the additional funding to Derby will unlock efficiencies, so will the vanguard programme and other local initiatives on, for example, dementia care to deliver an NHS that is fit for the future. It needs to evolve but is also needs to take the community with it. That is why it is right that we have a discussion about the voluntary sector without scaring people that decisions have been taken, when services such as the three I mentioned have already been protected and I am told that no decisions have been taken on the other voluntary’s services.
We are committed to spending more on the NHS in Derbyshire. That is the clear commitment the Prime Minister made. The CCG has made significant progress on delivering efficiencies against its 3% target, but we are building an NHS fit for the future, which includes ensuring that we give more money to Derbyshire. As part of the 10-year plan being devised by NHS England and NHS Improvement, Derbyshire will receive its fair share of that additional funding.
Question put and agreed to.
Oral Answers to Questions
Steve Barclay Excerpts(5 years, 9 months ago)
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Rosie Duffield (Canterbury) (Lab)
The Minister for Health (Stephen Barclay)
The Government are undertaking a wide range of analysis in support of our EU exit negotiations and preparations. Our overall programme of work is comprehensive, thorough and continuously updated.
Rosie Duffield
Brexit poses major challenges for the NHS and, in particular, the beleaguered and neglected hospitals of East Kent. Can the Minister reassure me—and the Royal College of Midwives and other bodies—that we will be able to recruit much needed migrant worker staff to the health and social care sector and will encourage them to stay after March 2019?
Stephen Barclay
We will remain committed to attracting the brightest and best. The hon. Lady says that her area is “beleaguered”; I remind her that the Kent and Medway sustainability and transformation partnership received £101.2 million more than it received in the previous year.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
Nearly 10,000 EU citizens work in the social care sector, caring for some of the most vulnerable people in society. What steps is my hon. Friend taking to ensure that there will be no shortage of people working in that sector once we have left the EU?
Stephen Barclay
My hon. Friend has raised an extremely important point. The Home Secretary recently announced a settlement scheme to enable those staff from the European economic area to remain. However, it is also important for us not to scare EU nationals, and to point out that there are now 4,500 more non-UK EU nationals working in the NHS than there were two years ago, at the time of the referendum. There is often a sense that there are fewer, but that is not the case.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
Stephen Barclay
I would have expected the hon. Lady to welcome the additional funds that have been announced—not just the £2 billion for social care, but the extra £20.5 billion a year, in real terms, that will be delivered through the long-term funding settlement. Instead of criticising that funding, the hon. Lady should welcome the Government’s commitment to increasing funds for the NHS and ensuring that it remains fit for the future.
Tom Pursglove (Corby) (Con)
Does my hon. Friend agree that one of the big benefits of our leaving the European Union is that we will not be sending billions of pounds a year to Brussels, and can instead spend that money on our health service, as per the new funding settlement?
Stephen Barclay
My hon. Friend is right to draw the House’s attention to the fact that there are a number of benefits from leaving the EU, not just in terms of the dividend to which he refers, but in terms of flexibility, for example in—[Interruption.] Labour Members do not seem to want to hear about the opportunities: opportunities on life sciences for example, in terms of getting medicines through in shorter timescales; opportunities on immigration; opportunities on professional qualifications; opportunities even on food labelling. It is important that we take those opportunities, as my hon. Friend says.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I too welcome the Secretary of State to his place. Membership of the European Medicines Agency has enabled early access to new drugs for UK patients through a single Europe-wide licensing system for a population of 500 million. Can the Minister clarify whether it is still the Government’s intention to remain a member of the EMA, and perhaps explain why on earth they voted against the EMA amendment last Tuesday?
Stephen Barclay
As the hon. Lady will be aware, we accepted the amendment, and it is our intention to work as closely as possible on that as part of taking that forward—[Interruption.] To correct the—[Interruption.]
Stephen Barclay
This is a near instantaneous correction, Mr Speaker, to recognise that what I should have clarified is that, following the vote in the House, it is our intention to work as closely as possible with that, and we recognise the point the hon. Lady makes.
Dr Whitford
It is still rather hard to understand why the Government voted against it in the first place. There is no current associate membership of the EMA for the UK to re-join as a third country, so if it is not possible to stay in the EMA what is the plan to avoid delays of up to a year in the licensing of new drugs for UK patients?
Stephen Barclay
There are a number of things that can be taken advantage of. We can use the flexibilities we have in terms of assessments with shorter timescales so that we can prioritise UK drugs that are bespoke to the UK market. There will be opportunities as part of this, as well as our working closely with European colleagues.
Peter Grant (Glenrothes) (SNP)
Nicky Morgan (Loughborough) (Con)
I welcome my right hon. Friend to his new position.
On Friday, a retired NHS consultant visited my surgery to talk about carpal tunnel syndrome. It appears that some of the operations are not going to happen now, and he said that they can happen at general practice level for about a third of the cost that they happen at hospital level. Is there an opportunity, yes, to save money but also to do things better by moving surgery out to community facilities? Can we explore such opportunities before these decisions are taken?
The Minister for Health (Stephen Barclay)
My right hon. Friend raises an important point about ensuring that procedures are done in the right place at the right cost, but primarily in a way that is best for the patient. I am happy to meet her to discuss the specifics of that and to see whether a change can be made.
Ellie Reeves (Lewisham West and Penge) (Lab)
Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
I welcome the Secretary of State to his place. I encourage him to visit the most rural part of England, up in Northumberland, to see for himself the challenges to healthcare provision due to the lack of a real rural financial formula. Will he update my constituents and the Save Rothbury Hospital campaign on how the review for that community hospital is going? That sort of low-level care is what makes the difference.
Stephen Barclay
I am happy to discuss with my hon. Friend how we provide support. Addressing the fact that 43% of patients in acutes do not actually clinically need to be in hospital is a key objective of the long-term plan to ensure that we get the right community services and relieve pressure from acutes.
Several hon. Members rose—